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OBR OncologyStudy Suggests Bladder-Sparing Potential in Muscle-Invasive Bladder Cancer

A chemotherapy and immunotherapy combo could be a potential game-changer in bladder cancer treatment.

A recent study has opened up new possibilities in the treatment of muscle-invasive bladder cancer (MIBC), suggesting that a combination of chemotherapy and immunotherapy could allow patients to avoid radical cystectomy, a procedure associated with significant morbidity and mortality risks.

HCN Medical Memo
This study’s findings could have significant implications for healthcare professionals treating MIBC. The potential to avoid radical cystectomy could change the treatment landscape, offering a less invasive alternative that could reduce patient morbidity and mortality. However, it’s crucial to note that patient selection is key to this approach’s success, and it may not be applicable to a wider group of patients.

Key Points

  • The phase 2 study tested transurethral resection of bladder tumor, along with cisplatin-based chemotherapy, as a bladder-sparing approach in MIBC.
  • The study enrolled 76 patients, 43% of whom achieved clinical complete response (cCR).
  • Patients with a cCR were allowed to proceed with additional immunotherapy without cystectomy.
  • About 70% of patients who opted for additional immunotherapy had no evidence of recurrence after two years.

Dr. Noah Taylor, a Radiation Oncologist at Evansville Cancer Center, The US Oncology Network, provides a critical analysis of the study. He notes that while the data is promising, only 30% of patients in the trial are without cystectomy at 2 years, with many expected to recur by 5 years. He contrasts this with bladder-sparing protocols using radiation therapy, which have been in use for over 25 years and achieve an 80% to 90% pathological CR rate.

Dr. Taylor suggests that a more effective trial design would incorporate immunotherapy and chemotherapy with radiation therapy. This approach could potentially offer patients the best chance of avoiding cystectomy and provide equivalent five-year survival to neoadjuvant chemotherapy followed by planned cystectomy. His commentary underscores the importance of considering all available treatment options and the potential benefits of combining therapies.

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